title: Multicenter audit of emergency endovascular repair of infrarenal aortic aneurysms.
abstract: BACKGROUND
  Emergency endovascular aneurysm repair (eEVAR) for infrarenal abdominal aortic aneurysm has become widely accepted as an alternative to open repair, if the aortic anatomy is favorable and endovascular expertise is readily available. The aim of this study is to report the outcome of eEVAR in Hong Kong.
  
  
  METHODS
  This was a retrospective review of prospectively collected data from Hong Kong Hospital Authority Clinical Data Analysis and Reporting System (CDARS), Clinical Management System (CMS), and departmental prospective computerized databases. Patient demographics, clinical and biochemical parameters, perioperative complications, and outcomes were recorded and analyzed. The independent sample t-test was used for continuous variables and the Fisher's exact test was used for nonparametric variables. Kaplan-Meier analysis was performed for overall survival and survival of subgroups. Binary logistic regression was performed for factors predicting perioperative mortality. SPSS software (version 15.0; SPSS Inc., Chicago, IL) was used for all statistical analyses.
  
  
  RESULTS
  A total of 40 patients (36 men with a mean age of 74.9 ± 1.53 years [range: 52-89 years]) underwent emergency eEVAR between January 2006 and September 2011 in 6 Hospital Authority Hospitals in Hong Kong. All patients were treated using commercially available aortoiliac endografts (including 26 bifurcated and 14 aorto-uniiliac grafts). There was 1 conversion from eEVAR to open repair. Blood loss, operating time, duration of stay in intensive care, and duration of stay in the hospital were 948 ± 495.5 mL, 194 ± 12.7 min, 4.7 ± 1.26 days, and 14.5 ± 2.19 days, respectively. The 7-day, 30-day, and 12-month mortality rates were 15%, 17.5%, and 35%, respectively. Six patients required reintervention on follow-up, and 8 patients died during hospitalization. Cox regression analysis of survival found that hypotension (P = 0.001) and being >76 years of age (P = 0.002) were associated with reduced overall survival. Binary logistic regression found that hypotension is associated with increased 30-day mortality (P = 0.026).
  
  
  CONCLUSIONS
  This audit shows that the results of eEVAR in Hong Kong are comparable to international standards. In the endovascular era, this may be an attractive alternative to emergency open aneurysm repair.
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Hong Kong.
authors.forename: Man-Fung
authors.initials: MF
authors.lastname: Ho
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Hong Kong. Electronic address: ycchan88@hkucc.hku.hk.
authors.forename: Yiu-Che
authors.initials: YC
authors.lastname: Chan
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Hong Kong.
authors.forename: Grace C
authors.initials: GC
authors.lastname: Cheung
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Hong Kong.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Cheng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D004632:Emergency Medical Services; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006723:Hong Kong; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D016017:Odds Ratio; D010865:Pilot Projects; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome